RFI Browser

RFI # 1370:
Healthcare Policy ID

Informal
Formal

Submitter

Millard Wayne

Description

#1) The REF for Healthcare Policy Identification in the 2110 says that it must be sent when the payer has a published enumerated healthcare policy code list available to providers via an un-secure public website. What is the definition of an enumerated healthcare policy code list?

#2) The PER segment that stores that website says that it only needs to be sent if a REF is used that refers to it. The REF in the 2110 says that one of the conditions is that the website exists. Is there any requirement that says you have to create the site if you do not currently have one?

Response

In answer to question #1, an enumerated healthcare policy code list is a listing of a payer's healthcare policies where a numeric or alpha-numeric value represents a code assigned to a specific policy for the purpose of subsequently identifying a specific policy by the codified value.

In answer to question #2, no, the REF & PER rules do not require a payer to create a web-site if one does not already exist nor does is it require a payer to publish their policies on an existing 'un-secure public site' if they do not currently provide that functionality.

However, if either the referenced REF or PER segment is present in the 835 , then the web-site, as described, is required.